Poor communication is the commonest cause of poor outcomes in medicine. Taking things for granted instead of asking questions is one form of poor communication.
She came in requesting the Encare Oval, a newly released contraceptive vaginal suppository that effervesced as it dissolved, causing a ‘fizzy’ sensation that was part of the marketing. She was not having any problems with her birth control pill, but all her friends were using the Encare Oval.
She was particularly interested in the fact that it ‘fizzed’ as it disolved.
I pointed out that it was less effective than the oral contraceptive she was currently using without problems, and that it had to be used each time she had intercourse. She said that she and her boyfriend had talked about it and she really wanted to try it. She knew it was less effective than the pill, but said that if she got pregnant, that would be alright. I wrote the prescription. Because of her enthusiasm about the ‘fizz’ I assumed she knew how to use it.
She came back approximately 8 weeks later, complaining of some urinary frequency, breast tenderness, and said that she had missed her period. She wanted to go back on her previous birth control pills because the Oval was giving her terrible heartburn.
“Heartburn?” I asked.
“Yes. Every time I take it, I get heartburn. “ (A bad feeling came over me.) “Besides, they’re really big. I have to cut it into pieces to swallow it.”
And, yes, she was pregnant. Happily, she and her boyfriend were thrilled at the pregnancy. But I revisit this episode regularly as a reminder that the assumptions we make and the questions we don’t ask can have consequences.